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Laparoscopic Gastric Bypass with Fundectomy and Gastric Remnant Exploration (LRYGBfse): Results at 5-Year Follow-up

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Abstract

Background

The laparoscopic Roux-en-Y gastric bypass (LRYGB) is the gold standard treatment for morbid obesity. After LRYGB, the endoscopic access to the gastric remnant and pancreaticobiliary system is challenging. The laparoscopic gastric bypass with fundectomy and exploration of the gastric remnant (LRYGBfse) was introduced in an attempt to overcome this limitation. The purpose of this study was to analyze the medium-term outcomes and safety of LRYGBfse.

Methods

Observational prospective single-arm multicenter cohort study. Patients with BMI > 35 kg/m2 were included. Previous open abdominal surgery was an exclusion criterion. Postoperative 1, 2, 3, and 5-year weight loss, BMI decrease, and percentage of excess weight loss (%EWL) were recorded. Wilcoxon signed rank sum test was used for paired data.

Results

Among 653 enrolled patients, 229 completed the 5-year follow-up. Preoperative median body weight (kg) and BMI (kg/m2) were 133.4 kg (interquartile range (IQR) = 12.0) and 48.2 kg/m2 (IQR = 10.1), respectively. Median 5-year body weight, BMI, and %EWL were 83.7 (IQR = 17.3), 31.2 (IQR = 7.7), and 74.8 (IQR = 23.4), respectively, all significantly improved compared to baseline (p = 0.002, p = 0.001, and p = 0.012, respectively). Comorbid improvement or resolution was observed in 88% of the patients. No major intraoperative complications were reported. Postoperative overall morbidity and mortality rates were 1 and 0%, respectively. Banding removal was necessary in one patient 62 months after the index operation.

Conclusions

The LRYGBfse seems safe and effective with durable results at 5-year follow-up. Endoscopic exploration of the gastric remnant is an additional valuable tool.

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Acknowledgements

The authors thank Maria Tosetti for her help with graphics and figures.

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Authors and Affiliations

  1. Department of General Surgery, Fondazione Salus Clinica Di Lorenzo, Via Vittorio Veneto n 37, Avezzano, L’Aquila, Italy

    Giovanni Lesti, Fabrizio Altorio & Francesco Lesti

  2. Department of Biomedical Science for Health, Division of General and Emergency Surgery, University of Milan, Milan, Milan, Italy

    Alberto Aiolfi & Gianluca Bonitta

  3. Division of General Surgery, Istituto Auxologico Italiano – IRCCS, Milan, Milan, Italy

    Enrico Mozzi

  4. Department of General Surgery, Istituto Clinico Humanitas San Pio X, Humanitas University, Milan, Milan, Italy

    Ezio Lattuada

  5. Department of General and Emergency Surgery, Ospedale Fatebenefratelli Sacra Famiglia, University of Milan, Erba, Como, Italy

    Marco Antonio Zappa

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  1. Giovanni Lesti
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  2. Alberto Aiolfi
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  3. Enrico Mozzi
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  4. Fabrizio Altorio
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  6. Francesco Lesti
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  7. Gianluca Bonitta
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  8. Marco Antonio Zappa
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Contributions

G.L., A.A, F.L., and M.Z. did the literature search.

G.L., A.A., and M.Z. formed the study design.

Data collection was done by G.L., A.A., E.M., F.A., E.L., and M.Z.

G.L., A.A., and G.B. analyzed the data.

G.L., A.A., and M.Z. interpreted the data.

Corresponding author

Correspondence to Alberto Aiolfi.

Ethics declarations

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of Interest

The authors declare that they have no conflict of interest.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

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Lesti, G., Aiolfi, A., Mozzi, E. et al. Laparoscopic Gastric Bypass with Fundectomy and Gastric Remnant Exploration (LRYGBfse): Results at 5-Year Follow-up. OBES SURG 28, 2626–2633 (2018). https://doi.org/10.1007/s11695-018-3220-1

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